Thirteen of the programs were primarily focused on adult nutrition and 7 were focused on pediatric nutrition.

Twelve programs appeared to have nutrition as their sole subspecialty focus, 8 were housed within gastroenterology fellowships. and 2 were within endocrinology fellowships.

Most programs included training in research, which is conducted during a second or third year, or both.

The decrease in numbers of programs appears to have resulted not only from relocation, retirement of key faculty members, and loss of training grants, but also because of the clearer definition of clinical nutrition training programs in this survey.

The changes also reflect a national trend toward decreasing subspecialization.

Within this climate, it is apparent that a new model for the training and career activities of physician nutrition specialists is needed that will attract more physicians into the discipline of nutrition.

Intersociety efforts are underway to address this need and to develop a unified voice that can guide clinical nutrition training for physicians into the 21st century.